Diabetes Programs Have Local Style 

By Jean Oxendine


Closing the Gap, Pacific Islander Health • June/July 2000


When the Centers for Disease Control and Prevention’s tor each system and provide feedback to Papa Ola Lokahi on strategies 

(CDC) Division of Diabetes Translation (DDT) launched to enhance the success of the training and community implementathe Diabetes Today program in 1991, they found that one tion programs, she added. Community groups are being encouraged 

size did not fit all. by the CDC to design their own projects. 

The CDC’s Diabetes Today National Training Center provides Developing the PDT program was especially challenging betraining programs for health care professionals and community lead­ cause a special curriculum is needed for the Pacific Basin to address the 

ers, who in turn can help local communities develop diabetes preven­ uniqueness of each group. This challenge is unique to Hawai‘i and 

tion initiatives. The goal is to empower those with diabetes, their Pacific Island jurisdictions because residents speak different languages 

families, health professionals, and others at and within each language there may be difthe community level to work together to pre- ferent dialects. For most of these populations, 

vent and control diabetes. A new and innovative public English is not the first language. “Our culBut the national training wasn’t work- tures are very much oral cultures,” said Ching.

ing for Native Hawaiians and other Pacific health approach for program “We do not rely on the written language as 

Islanders. Cultural issues are a big factor, ac- development in the Pacific. the primary communication method—we are 

cording to Betty Lamb, CDC’s Project Of­ more comfortable sitting in circles learning 

ficer for the Pacific Diabetes Today (PDT) pro­ from the sharing of stories. 

gram. “The people of the Pacific Region have unique historical and “What works for Hawai‘i does not necessarily work for all of the 

social experiences,” she said. Another reason the national Diabetes Pacific Islands, so we designed a project where each jurisdiction can 

Today program does not work in the Pacific was a lack of technical develop programs that work for them,” said Ching. 

assistance and follow-up support for the region, said Audrey Ching, “This program is a new and innovative public health approach 

project manager for the PDT Resource Center. for program development in the Pacific.” Papa Ola Lokahi conducted 

focus group interviews in American Samoa, Guam, Republic of Palau, 

The Pacific Shapes Its Own Programs Republic of the Marshall Islands, Commonwealth of the Northern 

Mariana islands, Federated States of Micronesia, and Hawai‘i. The 

Papa Ola Lokahi, a Native Hawaiian health consortium based in Expert Council oversaw the process and provided guidance. 

Honolulu, develops and maintains the regional Diabetes Today train­ The focus groups requested input from community members. 

ing consortium for CDC. The PDT program was designed to take They participated in evaluating the best ways to address diabetes in 

into account the cultural differences found in Hawai‘i and the Pacific their communities. Questionnaires, handouts, and sample teaching 

region. “We have the same requirements as the other Diabetes Today materials were given to participants to solicit the best strategies for 

program, but our style is different. We use existing community net­ each community. 

works to convene groups to come and work together to plan activities Materials were sometimes translated into the native language of 

that meet their particular geographic and cultural needs,” said Ching. the participants. “We can’t translate all of the material, but we always 

The program works to engage communities affected by diabetes have an on-site translator to assist in the process,” said Ching. The 

in describing the burden of diabetes in their community. The pro­ vocabulary of written materials is often too complex, and PDT atgram also helps communities plan interventions to reduce risk factors tempts to make it much easier by breaking down large words in to 

and associated complications of diabetes. There are high rates of dia­ several shorter ones. For example, the words ‘prevalence’ and ‘data’ 

betes among Native Hawaiians and other Pacific Islanders. For ex­ need to be broken down further to make sense with Pacific audiences. 

ample, approximately 30 percent of the population over age 15 suffer As a result of the input gathered from focus groups, the curricufrom Type II diabetes in the Marshall Islands, according to Lamb. lum will be revised and refined. The final curriculum will be comPapa Ola Lokahi assembled an advisory group called the Expert pleted by October 1. When each jurisdiction has its own PDT proCouncil to provide leadership in formulating the Pacific version of gram in place, Papa Ola Lokahi will continue to provide technical 

Diabetes Today. The 15-member Council represents the five major assistance and support to the community sites. 

Hawaiian islands and each Pacific jurisdiction—American Samoa, A draft of the Diabetes Today curriculum was developed for each 

Guam, Republic of Palau, Republic of the Marshall Islands, Com­ jurisdiction and Hawaii. Pilot testing took place in June in five sites— 

monwealth of the Northern Mariana Islands, and the Federated States Pohnpei, Kosrae, Palau, Hawai‘i and American Samoa. Each site idenof Micronesia. Council members consist of secretaries of health, health tified community members to invite to the training. The planning 

directors of jurisdictions, physicians, nurses, researchers, community efforts of these groups will be used to design and implement a plan for 

l

f

eaders, and clergy. 

“The experts define appropriate community models 

or the region,” said Lamb.They also establish and monieach community to address diabetes. Community leaders

continued on page 2>>>>

Office of Minority Health Resource Center 1 U.S. Department of Health and Human Services 
Diabetes Programs Have Local Style 

By Jean Oxendine


Closing the Gap, Pacific Islander Health • June/July 2000


can then train others through local diabetes support groups to continue to increase awareness and participation on the community level. 

This will empower communities to develop community initiated action plans. Papa Ola Lokahi will collect and analyze data to determine 

the relevance and cultural appropriateness of the PDT model for 

communities in the Pacific, according to Lamb. 

With the input from the jurisdictions, they will determine what 

is working and not working for each area and look at ways to make 

changes as necessary to best suit the people it aims to serve. 

Within the first five years of the program, training, marketing 

and promotion, and evaluation plans will be developed. Training will 

take place throughout the Pacific region and Hawai‘i. Technical assistance and follow-up visits will be conducted with the jurisdiction and 

Hawai‘i PDT training sites. 

For more information on the Pacific Diabetes Today program, contact Audrey Ching at Papa Ola Lokahi at (808)536-9453 or e-mail at 

audrey_ching@yahoo.com

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Office of Minority Health Resource Center 2 U.S. Department of Health and Human Services